Management of burns
About the Authors (Burn Service WA):
• Sharon Rowe, Clinical Nurse Consultant, State Adult Burn Unit, Fiona Stanley Hospital
• Tania McWilliams, Clinical Nurse Consultant, Perth Children’s Hospital
• Professor Fiona Wood, Director, Burn Service WA
WA covers 2.6 million sq kms with a population of 2.6 million people. There is one adult burns unit, located at Fiona Stanley Hospital and one paediatric unit at Perth Children’s Hospital.
Together, they provide a state service utilising onsite appointments, telehealth and digital imaging to ensure all people who sustain a burn injury received timely and appropriate first aid and wound care.
Burns are common injuries that vary in severity from small superficial scalds to massive full-thickness flame burns with high morbidity and mortality.
Management of smaller burns in the community is possible with the correct first aid, appropriate burns dressings and wound management.
Correct treatment will reduce the risk of infection or the burn converting to a deeper burn requiring specialist review or surgery. The following information is aimed at highlighting the importance of correct first aid, appropriate dressing selection and early referral, resulting in the best outcome for the patient.
What to do at point of injury
Every intervention from the point of injury impacts on the outcome for each patient. Whatever the cause of the burn, early intervention with evidence-based treatment improves outcomes and reduces complications and mortality rates. The Australian New Zealand Burns Association recommends 20 minutes of cool running water within the first three hours of a burn injury, as this has shown to reduce time to healing and the need for surgery.
The first 48 hours
Burn wounds are dynamic and change for the first 48 hours post injury. For this reason, the practice of Burn Service WA is to review all burns within 48 to 72 hours of injury wherever possible. The use of antimicrobial dressings e.g. Acticoat™ for the first 48 hours post injury has been shown to reduce infection. Nanocrystalline Ag (Ag) dressing – Acticoat™ releases silver slowly within 30 minutes of application and is toxic to microorganisms on the wound bed. It is the protocol of Burn Service WA to dress all burn wounds, except the face, with this
product for the first 48 hours. There is no requirement for prophylactic oral antibiotics.
- Apply Intrasite gel to the Acticoat™ and place it on the burn area. The Acticoat™ can also be moistened with sterile water.
- Apply a secondary dressing such as a hydrocolloid or foam, or sterile gauze moistened with sterile water.
After the first 48 hours
After 48 hours the wound requires review. Burn Service WA does not routinely continue Ag dressings after 48 hours. This is due to in vitro evidence that Ag can inhibit keratinocytes and fibroblasts, potentially prolonging time to healing. Indications for continuing Ag dressings after 48 hours include if the patient has presented late or the wound appears infected.
Time to healing impacts on scar formation. Burns that take longer than 21 days to heal have a high rate of hypertrophic scarring. For this reason, early referral for discussion is recommended (i.e. within 48 to 72 hours) so that appropriate surgery, functional movement and scar management can be commenced.
Please note that while Fiona Stanley Hospital has a paediatric emergency department, there are no paediatric burns facilities onsite. All paediatric referrals should be directed to Perth Children’s Hospital.
For more information regarding referrals to the Fiona Stanley Hospital – Adult Burn Service and the Perth Children’s Hospital – Paediatric Burn Service, please see the ‘Specialised Burns Management Requests’ page on HealthPathways.
If you would like further information on assessment and management please see the ‘Burns Injuries’ HealthPathways.
For specialised burns advice phone:
Fiona Stanley Hospital – Adults Burn Service
• 6152 2222 and ask for the registrar on call for burns; or
• 6152 7611 (Monday to Friday 7:30am – 4pm) and speak to the clinical nurse consultant
Perth Children’s Hospital – Paediatric Burn Service
• 6456 2222 and ask to speak to the registrar on call for burns; or
• 6456 3630 (Monday to Friday 7:00am – 3:30pm) and speak to the clinical nurse consultant